Breastfeeding and the Sexual Abuse Survivor

We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time

Becoming a mother can be
at once joyous and stressful. For women who have been sexually abused,
the transition to motherhood can bring unique challenges. As LLL Leaders
we may be asked to help. Knowledge about sexual abuse can help a Leader
in two ways:

It may explain concerns or behaviors we might not otherwise understand;

It can make us more comfortable
and therefore more effective when mothers choose to share this information
with us.

General Characteristics

In the past 20 years there
has been a veritable explosion of knowledge about sexual abuse. The
long-term effects of child sexual abuse have been carefully documented
in hundreds of studies. Leaders need to keep in mind several cautions
about this information:

Not every woman who has
been sexually abused responds in the same way. There is a
tendency to think that all sexual abuse survivors will look and act
the same or experience the same types of difficulties. Sexual abuse
survivors vary in the amount of trauma they've experienced, influencing
the severity and type of symptoms they might exhibit. Experiences
tend to be more traumatic if a family member or close friend was involved,
if sexual penetration was involved, if force or coercion was involved,
if the abuse happened often and was repeated over a period of years,
if there was no adult to believe or support them during childhood.
But even women who have had similar abuse experiences may respond quite
differently to them.

Other traumatic events
during childhood can cause symptoms similar to those caused by sexual
abuse. Sexual abuse is not the only form of trauma children
can experience. Physical abuse, neglect, divorce, death of a parent,
even invasive medical procedures can all cause difficulties for children
when they grow up. Occasionally women who have experienced one
of these other types of trauma have been told they "must have" been
sexually abused. We need to walk a fine line between realizing
sexual abuse may be a possibility and not attributing every difficulty
a mother experiences to sexual abuse.

The process of healing
is individual. Where a woman is in her healing process will
influence the types of symptoms she has and feelings she must deal with.
Just as the type of trauma a woman experiences varies, so too does the
level of healing. We cannot assume that because we see women at the
same time in their lives (when they have a new baby) that they are at
the same place in their healing process, but may find that they still
have some questions and concerns.

Reactions Leaders May Observe

The long-term effects of
sexual abuse are listed in Table 2. Not every survivor will experience
all or even most of these. However, this listing demonstrates
the wide range of repercussions sexual abuse can have. In addition to
these long-term effects, Leaders may observe some other reactions:

Lack of confidence in
her body. A mother may feel that her body has been damaged
by her experience. She may have learned not to trust her feelings
about her body. Sometimes this lack of confidence is reinforced if the
woman has had a difficult birth. She may not expect that her body
will function correctly when it comes to producing milk and may be quite
anxious. She may experience intense shame over her breasts. The physical sensations associated with breastfeeding may remind her of her sexual abuse experience.

Intense need to do everything
"right." A mother may try to parent her children very differently
from the way she was parented. This is a laudable goal but can
be taken to extremes. A mother with a difficult childhood may
try to be perfect. This may manifest in "selfless devotion," meeting
baby's needs to the exclusion of all of her own. With older children,
a mother may be reluctant to set limits, only later to explode with
anger and frustration. She may also be highly critical of the
parenting practices of other mothers.

Tendency to see herself
as very different from other mothers. The effects of child
sexual abuse can be stigmatizing. A mother may believe she is different
from other mothers in ways not directly related to the abuse. For example,
she may mention feeling as though the difficulties she has with her
children-be it tantrums, defiance or other acting out-are due to her
past history of sexual abuse. In other words, if she were not
a sexual abuse survivor, all would be well between her and her children.
Most Leaders can offer lots of reassurance to mothers in this regard.

How Leaders Can Help

Leaders can help mothers
who are sexual abuse survivors in a number of ways. In all situations,
remember that every mother is different; what may be a problem for one
mother may not even bother another.

Offer suggestions that
will make breastfeeding more comfortable. It is not a good idea
to approach a mother about possible sexual abuse, as some recent literature
recommends. Some mothers may tell you about their experience; others
will not. Whether she does or doesn't, a Leader can offer information
that can help make breastfeeding a more comfortable experience.

Through your conversation
with a mother, try to determine which situations make her uncomfortable.
For example, she may have trouble with skin-to-skin contact, a playful
older baby or nighttime nursing. Help the mother set limits and boundaries.
Some mothers limit breastfeeding to daytime because nighttime nursing
reminds them of nighttime sexual abuse. Some mothers want to give their
babies the benefits of breast milk but cannot tolerate the baby at the
breast. These mothers may opt to pump and give bottles of expressed
milk. Be flexible and creative to help the mother find a solution that
works.

Help mothers learn what
is normal. Mothers who have been sexually abused may have
difficulty knowing what is normal when breastfeeding. Most mothers
derive at least some sensual pleasure from nursing but mothers who have
been sexually abused may be concerned about these feelings. You
can offer reassurance, perhaps even bringing up some of the pleasurable
aspects of nursing. Also, emphasizing the biological function
of breasts may tone down their sexual connotation.

Some mothers from abusive
homes can be so anxious about doing a good job parenting they are reluctant
to set limits for their children. They may not know the normal range
of behaviors for various ages. A discussion on loving guidance can help
a mother who has not had positive role models learn more effective and
loving ways to parent her children.

Suggest she see a qualified
counselor. If a mother tells you that she been sexually abused,
talk with her about the importance of seeing a professional who can
help (if she is not already doing so). We need to remember that as Leaders
our primary objective is breastfeeding support. While it is important
to be sympathetic and encouraging, be careful if you find yourself becoming
the main source of emotional support for issues only tangentially related
to breastfeeding. A mother experiencing serious difficulties or difficulties
outside the realm of breastfeeding needs to be encouraged to seek appropriate
help.

Help educate health care
providers about the normal course of breastfeeding, for example,
breastfeeding on demand, co-sleeping and late weaning. This is
an area where a Leader's expertise can make a significant difference.
A surprising number of health care providers in the sexual abuse field
feel that attachment-parenting practices are a negative result of the
sexual abuse experience. We can educate mental health providers,
directly or through the mother, about normal breastfeeding practices,
especially from a global perspective.

Helping a mother who has
been sexually abused can be one of the more challenging situations you
encounter as a Leader. It can also be one of the most rewarding.
I've known many sexual abuse survivors who have grown past their abusive
experience to become nurturing mothers, fathers, even LLL Leaders.
With encouragement and breastfeeding support, we can help make that
happen.

What Leaders Can Do to Help Breastfeeding Mothers Who Are Sexual Abuse Survivors

Offer suggestions that will help make breastfeeding a more comfortable experience.

Help a mother learn what is normal for breastfeeding.

Encourage a mother to seek qualified professional help with problems beyond the scope of
breastfeeding.

Help educate health care providers about the normal course of breastfeeding.

Table 1 - Overview of Sexual Abuse

Incidence:

Around 20% of all women

Peak age of vulnerability:

7-13 years of age (but can occur earlier or later)

Abusers:

90% are male; 70-90%
are known to their victims. For girls, 30-50% of abusers are within
the family.

Table 2 - Overview of Long-Term Effects of Sexual Abuse

Post-Traumatic Stress Disorder (PTSD)

A mother may experience
sudden and intrusive flashbacks perceived in the present.

Cognitive Distortions

A mother may overestimate
danger to herself or her baby. She may perceive herself as weak
or helpless.

A mother may have
difficulty separating her emotional state from the reactions of
others. She may have difficulties with self-protection, leading
her to become a victim again.

Avoidance

A mother may experience
dissociation, which includes alterations in body perception (including
feelings of separation from her body), emotional numbing, amnesia
regarding painful memories, and multiple personality disorders.
Other types of avoidant behavior include substance abuse, suicidal
thoughts and attempts, "tension- reducing activities" such as
indiscriminate sexual behavior, bingeing and purging, or self-mutilation.

Interpersonal Difficulties

A mother may have
problems with interpersonal relationships. She may adopt an "avoidant"
style, characterized by low interdependency, low self-disclosure
and lack of warmth. Or she may adopt an "intrusive" style,
characterized by extremely high needs for closeness, excessive
self-disclosure and a demanding, controlling style.

References

Finkelhor, D. Current
information on the scope and nature of child sexual abuse. Future
for Children 1994; 4:31-53.

Becker-Lausen, F and Mallon-Kraft,
S. Pandemic outcomes: the intimacy variable. Paper presented
at the 4th International Family Violence Research Conference, Durham,
New Hampshire, July 1995.